Servier Traveling Fellowship

The American Venous Forum Foundation (AVFF) periodically offers the Servier Traveling Fellowship in Venous and Lymphatic Disease. The winners of the Servier Traveling Fellowship are selected and announced at the AVF Annual Meeting. The award will provide two (2) fellows an opportunity to travel to the European Venous Forum Annual Meeting (generally in June) to present his or her scientific research and subsequently to the AVF Annual Meeting (generally in following February) to present.

Eligibility for the Servier Traveling Fellowship

Abstract submitted must represent original, basic or clinical research in venous or lymphatic disease.

Applying resident or fellow MUST be enrolled in a United States training program

Accepted abstract authors must submit a manuscript for publication to the Journal of Vascular Surgery: Venous and Lymphatic Disorders.

Application Process

Eligible applicants must submit an abstract for consideration to the American Venous Forum (AVF) Annual Meeting during the Call for Abstracts period, generally between June and September.

At the time of submission, eligible applicants must indicate desire to be considered for the Servier Traveling Fellowship.

Selection Process

All abstracts are scored by the Program Committee and selected for inclusion in the Annual Meeting Program.

Interested candidates whose abstracts are accepted for the Annual Meeting Program are screened for eligibility for the Servier Traveling Fellowship.

The presenting eligible candidates will be judged by a panel made up of the AVF and AVFF Leadership, based on the quality of their scientific work and presentation. Two (2) winners will be chosen and announced during the Award Ceremony at the Annual Meeting.

Reimbursement

Following the Annual Meeting, the AVF Office will coordinate travel of the two (2) winners.

European Venous Forum (EVF): The Two (2) winners of the AVFF Servier Traveling Fellowship will travel to the EVF annual meeting in Europe (generally in June the year the award is provided). AVF will reimburse each winner up to $3,000 for travel expenses. An expense report and receipts for reimbursed expenses must be returned to the AVF office within 60 days of return from the EVF meeting. If reimbursement documents are not received by year-end, AVF will not be held responsible for those expenses. AVF will reimburse each winner for the following expenses:

Round trip Economy airfare up to $1500

Hotel accommodations up to $700

Meals up to $300

Ground transportation up to $200

EVF registration $300 (Trainee rate)

Winner Report (AVF): The two (2) winners are expected to return the following year to the AVF Annual Meeting to present highlights of their Fellowship Experience. AVF will provide complimentary registration for the Annual Meeting and up to $1000 in travel/hotel accommodations to each winner.

Award Recipient Responsibilities

The two (2) winners of the AVFF Servier Traveling Fellowship will attend the full conference and present their scientific research at the EVF.

The presentation must include an appreciation slide displaying the Les Laboratories Servier logo.

The two (2) winners then submit a final expense report with receipts to AVF for European travel expenses within 60 days to be eligible for reimbursement.

The following year, the two (2) winners will attend the AVF’s Annual Meeting and present highlights of their Fellowship experience to meeting attendees. The meeting registration is waived.

The two (2) winners must each submit a manuscript to the Journal of Vascular Surgery: Venous and Lymphatic Disorders on the outcome of the research, within a 1 year timeframe from presentation.

Timeline

June – the Call for Application opens

September – the Application process closes

October – the Program Committee scores the Abstracts

November – the applicants are contacted

February – abstracts are presented at the AVF Annual meeting and are scored by the selected panel. The two (2) award winners are announced and presented with an award at the AVF Annual Meeting Awards Ceremony

June – The two (2) winners present their abstracts at the EVF meeting in Europe

By August 31st – The two (2) winners must submit expense report for travel reimbursement according to the reimbursement policy

February of following year – The two (2) winners attend the AVF Annual Meeting to present highlights of their Fellowship experience

Summary:

Lymphedema is swelling in the leg, arm or other parts of the body due to the body’s inability to effectively remove lymph fluid (which contains proteins, fatty acids, waste from cell feeding and bacteria that enter the body). Lymphedema can happen because the formation of the lymph vessels during maturation was less than adequate (called primary lymphedema) or damage (injury) has occurred to the normally formed lymph channels and lymph nodes during surgery, from infection, from radiation treatment or other causes. It can also occur from too much lymph fluid being made such as can happen when venous disease is present. Before treating lymphedema itself a physician has to be sure that there is no infectious or other acute medical problem that must be dealt with. The most important medical therapy used for lymphedema is external compression treatments (massage, compression pumping, compression wraps and eventually compression stockings) to decrease the swelling and to keep it down. Surgery for lymphedema is a last option for only a select group of patients.

My doctor thinks that my baby had a congenital venous malformation, what does this mean?

My seven year old hasa birth mark on the left leg and back, a varicose vein that I just noticed that goes down the outside of the leg, and his leg on that side may be a little bigger than the other side. What could be the problem?

My child has a congenital venous malformation, are we at risk for other children with the same problem?

Summary:

A hemangioma, commonly known as a “strawberry birthmark”, is the most common benign tumor of infancy. These vascular tumors grow very fast during the first year of life to the fear of the parents but then stop growing and actually get smaller very slowly during childhood so that they are usually gone by school age. Only in rare cases is any treatment needed. Congenital vascular malformations are the result of blood vessels not maturing (going to full development) while the infant is still in the mother’s womb. If this happens early, the abnormal blood vessels do not have the form usually seen with blood vessels and appears more like a spongy mass which can involve neighboring body parts. If this happens later in the pregnancy, the blood vessels look more normal but are abnormally small, abnormally large or have unusually connections with other blood vessels. As a part of congenital vascular malformations, the venous malformation is the most common and possibly the easiest to manage. Congenital vascular malformations do not go away and will require a lifetime of care.

Original author: Peter Neglén

Abstracted by Gary W. Lemmon

Content:

Diagnosis

Therapy

Conclusions

Commonly asked questions

Will treating iliac vein narrowing I have heal my leg ulcer?

What are the stents made of and can I feel them?

Summary:

Iliac vein or vena cava vein blockage or narrowing prevents blood flow from getting out of the leg(s) since these are the major exit sites for this blood to get back to the heart. Removing blockages from these veins is possible with techniques that allow one to place a dilating balloon and stent (metallic support device) inside the narrowed vein. In the rare case that this is not successful, there are surgical procedures which can help.

Content:

What happens to the arm if the vein is taken from that location to be transplanted to the leg veins?

Summary:

Vein valves that do not work will cause blood to flow backward in the veins into the legs. This leads to problems with swelling, skin changes and even breakdown of the skin (ulcers). There are ways to stop this abnormal backward flow of blood by fixing the vein valves. If the valve is still present but just not meeting properly, the valve can be fixed with fine sutures. If the valve is totally damaged, one must place the refluxing system below a working valve in another part of the leg veins (transposition) or must take one from the arm as a transplant. Other techniques are being investigated but so far these are the more common ways to fix the problem.

Summary:

The superficial leg veins can allow the backward flow of blood down the veins and result in lower leg swelling, skin changes and even skin breakdown (ulcers). By removing these non-working veins, the symptoms are made better. One can remove these veins from the body by pulling them out (stripping) or by burning the inside so that they scar shut (laser or radiowave ablation, or sclerotherapy). The patient must know that there can be problems with each method of removal and must believe that the benefits are better than the risks involved.

Summary:

The information provided here is to serve as a guideline regarding one possible treatment (sclerotherapy) and what to expect. Therapy is very individualized to a single patient and the best treatment options for your condition should be discuss with physicians skilled in the evaluation and treatment of vein problems. Most patients will require several sclerotherapy treatments to fully treat their venous disease and may have veins return over a period of time requiring further therapy.

Abstracted by Michael C. Dalsing.

Content:

Introduction

Etiology and Diagnosis

Treatment and Results

Conclusions

Commonly asked questions

What are spider veins?

What causes spider veins?

Are there ways to get rid of my spider veins?

Summary:

Spider veins are very small blemishes within the skin. The cause of the spider veins must be sought and treated prior to taking care of the skin blemish. To eliminate the spider veins, currently two treatments are commonly used; Laser treatment uses light to heat the spider vein resulting in scarring while sclerotherapy uses drugs to damage the inside of the vein resulting in scarring. Each method has risks including a worsened cosmetic appearance for the potential benefit of eliminating the blemish.

Original authors: Gregory L. Moneta and Hugo Partsch

Abstracted by Teresa L. Carman

Content:

Compression stockings are hard to get on. Do I have to wear them every day?

How can I make the compression stockings easier to put on?

Which stocking is the best?

Summary:

The abnormal backward flow of blood in the leg veins or blockages to the blood getting out of the leg can lead to problem including swelling, skin changes and even ulcers. Once the diagnosis is made, placing compression from the outside of the leg can correct many of the underlying problems such that the symptoms get better. Compression therapy comes in many forms and some devices are better for healing ulcers (open skin lesions) and other for maintaining a steady state within the leg.

Abstracted by Teresa L. Carman

Content:

Do I need to bring anything to my first appointment with the vein specialist?

Do I need to fast or not eat before my appointment?

Will I need a surgery for my veins?

Summary:

Evaluation of venous disease whether asymptomatic or causing severe symptoms begins with a good history and a physical examination including laboratory studies if necessary. Most venous disease is not a major problem for the patient and does not require a surgery or procedure. Patients with bothersome symptoms or recurrent ulcers may benefit from a procedure or surgery.

Summary:

Two other major contributors to venous insufficiency are venous reflux and venous obstruction. Regardless of the cause, chronic venous insufficiency and chronic venous hypertension may result in leg swelling, skin darkening or hyperpigmentation, skin thickening or lipodermatosclerosis (fat and skin scar development), and even sores or ulcers. Your doctor can do laboratory testing and vascular testing to determine what conditions you may have.

Summary:

Axillo-subclavian vein thrombosis occurs as a result of abnormal muscle and/or rib anomalies of the thoracic outlet at the base of the neck and ribcage. Treatment should be done rapidly and involves three steps which includes dissolving the clot, maintaining anticoagulation (stopping any new clots from forming) with a blood thinner and surgical treatment to eliminate the external compression on the subclavian vein.

Abstracted by Gary W. Lemmon

Content:

Is it safe to leave the filter in and does it has to stay there for my lifetime?

Can the filter be placed for blood clots in the arms rather than the legs?

With so many filter types which one is the best for me?

Summary:

Blood clots from the large veins of the legs and pelvis can produce life threatening Pulmonary Embolism (PE) if left untreated such as when standard therapy cannot be used. PE management might include placement of an inferior vena cava filter effective in preventing PE. However filter does not reduce the risk to zero nor does it treat the underlying venous clotting problem. Therefore continued anticoagulant therapy (blood thinners) should be used when possible.

Abstracted by Michael C. Dalsing

Content:

Venous narrowing (stenosis) may be seen as one cause of the blood clot

Risks connected to removing acute blood clot

Expected results

Conclusion

Commonly asked questions

What is thrombolysis?

Which patients derive the most benefit from catheter-directed thrombolysis?

What are the objectives of thrombolysis or surgical thrombectomy?

Are there other benefits of catheter-directed thrombolysis or surgical thrombectomy?

What are the risks of using thrombolysis to remove free blood clot?

Are there alternatives to catheter-directed thrombolysis for extensive venous thrombosis?

Why are blood thinner used after thrombolysis or surgical thrombectomy?

Summary:

There are several interventional treatment options for acute deep venous thrombosis (DVT): catheter-directed thrombolysis with or without mechanical device use is the preferred treatment option for patients with iliofemoral deep venous thrombosis who are otherwise healthy and have no contraindication to receiving a thrombolytic drug. If thrombolysis is too high a risk, venous thrombectomy is recommended. For patients who are bedridden and those who are in very poor health, treatment with anticoagulation agents (blood-thinning agents) alone may be advisable. Successful and timely clot removal in patients with iliofemoral DVT results is less post-thrombotic symptoms and an improved health-related quality of life.

Summary:

DVT and PE are treated essentially the same. In this chapter you will discover what is the treatment’s strategy using heparin (often LMWH) and warfarin. In the case of a recurrent event, warfarin may be continued for life. If blood thinners aren’t able to be used, a filter can be placed to prevent the clot from traveling to the lungs. If symptoms are very severe, removal of the clot from the vein, usually by thrombolysis, can be undertaken.

Abstracted by Kellie R. Brown

Content:

What are the most common signs and symptoms of a Deep Venous Thrombosis (DVT)?

What are the most common signs and symptoms of a Pulmonary Embolus (PE)?

How is a DVT diagnosed?

How is a PE diagnosed?

Conclusion

Summary:

The most common symptoms of DVT are pain and swelling, but many DVTs have no symptoms. The most common symptoms of PE are sudden onset of chest pain and shortness of breath. A low threshold to get further tests is needed in order to diagnose most DVTs because the symptoms are vague. DVT is usually diagnosed with ultrasound, and PE is usually diagnosed with CT scan, but other tests may be needed to make the diagnosis.

Summary:

Most cases of Superficial Venous Thrombosis are not noticed or taken seriously by the patient and often get better without treatment. It is important however to make sure that the patient does not have a condition which is causing more than normal blood clotting (hypercoagulable states) or has an unknown cancer. In this chapter you will learn about the diagnostic tests and treatment’s options for the Superficial Venous Thrombosis.

Summary:

Venous thromboembolism (VTE), which is either deep vein thrombosis (DVT) or pulmonary embolus (PE), is the 4th leading cause of death in Western society. Thus, preventing VTE is very important. This chapter will discuss the main ways to prevent a DVT or PE.

Factor Elevations: Elevations in the levels of different proteins in the blood that participate in the clotting process

Hyperhomocysteinemia

Other Inherited Clotting Disorders

AntiPhospholipidantibody Syndrome (APS)

How common is it?

How and when do you test for this?

What is the risk of VTE in people with APS?

How do you treat APS?

Heparin Induced Thrombocytopenia

Heparin induced thrombocytopenia (HIT)

How common is HIT?

How and when do you test for HIT?

What is the risk of VTE in a person with HIT?

How do you treat HIT?

Cancer

Conclusion

Summary:

The normal balance between clot formation and breakdown can be changed by the presence of certain genetic or acquired defects leading to abnormal clot formation. In this chapter you will learn about different factors that can increase the risk of VTE. These conditions should be looked for in any person who has a VTE, unless the cause is already known.

Abstracted by Kellie R. Brown

Content:

How common are Deep Vein Thrombosis (DVT) and Pulmonary Embolism (PE)?

What causes DVT and PE (venous thromboembolism -VTE)?

What are the risk factors for VTE?

Age, Gender and Race

Surgery

Trauma

Medical Illness

Immobilization or Travel

Primary Blood Clotting Disorders

Oral Contraceptives and Hormonal Therapy

Pregnancy

How does clot affect the vein?

Does the vein return to normal after the clot resolves?

Conclusion

Summary:

This chapter will discuss the common risk factors for Deep Vein Thrombosis (DVT: blood clots forming in the deep veins often of the leg, pelvic or abdomen but can also occur in the arm veins), the changes that occur in a vein after a clot has formed, and what happens to the clot over time. Among patients with DVT, one third of them are diagnosed due to a pulmonary embolus (PE), a blood clot traveling in the blood vessels to the lung, causing shortness of breath and chest pain. The long-term effects of DVT, called post-thrombotic syndrome (PTS), can be associated with skin discoloration, ulceration and other skin changes in the legs.

Summary: This chapter will tell you how blood flow circulates in the blood vessels called arteries from heart to the legs and back to the heart through the veins, blood vessels that return the nutritionally depleted blood. You will learn about normal venous return and abnormal venous function, which may result in swelling or edema and skin damage such a discoloration, darkening, thickening and ulceration.

Axillary/Subclavian Vein Thrombosis (Clot) and Its Treatment: Adapted from Chapter 24 of the “Handbook of Venous Disorders”. Original authors: Richard M. Green and Robert Rosen. Abstracted by Gary W. Lemmon.

Physiology of Venous Insufficiency:Adapted from Chapter 5 of the “Handbook of Venous Disorders”. Original authors: Kevin G. Burnand and Ashar Wadoodi. Abstracted by Teresa L. Carman.